50/III

55

LSD

71

{
Published as a separate and in The Journal o[ Psychology, 1955, 39, 1Z7-155. LYSERGIC ACID DIETHYLAMIDE (LSD-25): [II. AS AN

ADJUNCT TO PSYCHOTHERAPY WITH ELIMINATION OF FEAR OF HOMOSEXUALITY* New York City HAROLD A. ABRAMSON I

A.

INTRODUCTION

The discovery of lysergic acid diethylamide's unique effects on the psyche in the laboratories of Sandoz Chemical Works opened a new field of investigation of aids in psychotherapy. In the experience of the writer, the uniqueness of the action of the drug has certain favorable characteristics which may help the patient and the physician deal with analysis of the patient's reactions. These may be briefly listed: (a) Pharmacologic safety. (b) Effectiveness in small doses (20 gamma to 40 gamma) for therapeutic interviews. In this paper a verbatim transcript of a four-hour interview under 40 gamma will be reported. (c) The patient is conscious, co6perative and better able to integrate material of psychodynamic significance. (d) The difficulties of the procedure of narcosynthesis are eliminated with the patient

, _!;i undergoing an essentially elated disturbance in ego function which is also _ accompanied by integrative forces so that it may be thought of as hebesynthesis. (e) The drug may be given repeatedly. A patient who also was a sub',_ ject in the first paper of this series took 25 gamma to 100 gamma more _ than 50 times. ([) There is no evidence of addiction. (g) The effects .... usually wear off within 12 hours. _,_ (h) Patients _ of taking LSD-25 in the dose range stated. ' . _ ..... i, :i_ " 'i :_ -,_ "_ ...... B. HISTORICAL usually like the experience

There have been several recent reports on the use of LSD-25 in psychotherapy, but to the knowledge of the writer, there have been no reports of its use in the psychoanalytic interview with verbatim data of the type to bepresented be of interest. here. Some of the published reports of other investigators may In particular, the papers of Stoll (17), Stoll and Hofmann

*Received in the Editorial Office on September 20, 1954., and published immediately at Provincetown, Massachusetts. Copyright by The Journal Press. 1This investigation was supported by a grant from the Geschickter Fund for Medical the lysergic acid diethylamide are indebted to Sandoz Pharmaceuticals for supplies of Research, Incorporated. We and its derivatives.

127

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PSYCHOLOGY

(18), Laszlo (12), Condrau (5), Becket (3), Savage 19), Busch and Johnson (4), Fervers (7), Frederking (9), Forrer and Goldner (8), Abramson et al. (2), Sandison (14), Sandison, Spencer, and Whitelaw (15), and Sloane and Doust (16) may be consulted. In addition, the papers of DeShon, Rinkel, and Solomon (6), Hoff and Arnold (10), and Rinkel et al. (13) are of importance. Sandison, Spencer, and x,Vhitelaw publish a list of instructions to the nursing staff attending patients receiving treatment by LSD-25. They generally dealt with a different group of patients than those treated by the writer and the special patient reported here, in detail. Their instructions may well be used as a basis for therapy with an in-patient service. In the studies by the writer, the prolonged time of the interview or experimental period, often included discussions on the way home with a patient, at dinner, or wherever the patient happened to be. It is believed that the ambulatory technique not recommended by some writers is perfectly safe, if carried out with the dosage recommended and with the precautions mentioned. Oral administration was employed. There is one important difference between the methods of Sandison, Spencer, and Whitelaw and the writer. They state: "No special preparation is required. The patient should be told at least the day before that treatment is to be given." I believe that the amount of anxiety which may be mobilized in ambulatory patients who expect to take LSD-25 is much reduced if a two-week period of notice and questioning is permitted to precede the LSD-25 interview.
C. PREPARATION AND _[ANAGEMENT OF THE AMBULATORY PATIENT

In preparatory discussion with the patients, emphasis is placed on the therapeutic value of the drug. The unusual vegetative and psychic effects are related to the patient at least two weeks in advance of the interview with LSD-25. Anxiety may arise in spite of the most careful preparation. This anxiety should be met with confidence by the therapist who should inform the patient that the unusual psychic effects of the drug can only lead to beneficial results. The interviews may take place on the couch, sitting up, or with the patient walking about. Any special procedure usually practiced by the therapist in the interview situation should be replaced by a permissive expectation that the integrative functions of the patient's psyche will know best how to regulate the interview, provided that the patient remains within the direct control of the therapist. With doses of 40 gamma and below, the interview may last four hours but the effect of the drug may persist for another four to eight hours. The patient should be informed: (a) That

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there are no after-effects. (b) That a relative or friend should call for him at a stated time (four hours after administration). (c) That he must remain at home or with friends until the next morning. The patient must be impressed with this modus operandi. While the effect may outwardly be negligible in certain ambulatory patients, it is the action of choice to keep the patient accompanied at home until the next day when all pharmacological effects due to the drug have invariably disappeared. (d) Driving a car, using machinery, or walking alone is prohibited. (e) A barbiturate, secobarbital (1_ grams to 3 grams), is given to the patient to take at bedtime. (/) The four-hour interview is interrupted at about 50-minute intervals. The therapist is advised to have his secretary offer the patient coffee and simple foods throughout the rest periods. This may not only be desirable physiologically but also provides a milieu which diminishes the under-current of anxiety provoked by the drug itself. For short interviews of one to two hours, advantage should be taken of the data provided in the first paper of this series. A study of the curves for doses of 50 gamma indicates that the peak reactions are observed between 1_ and 3 hours. This should be the period of choice. However, the patients have always been kept in the office under control a minimum of four hours. No method (except deep sedation) is known to completely stop the LSD-25 reaction once it has begun. Sedation may, however, complicate the situation more. One patient (F.W.) who received 50 gamma at 8:00 V.M. showed marked signs of the LSD-25 reaction at 1:00 A.M., even though 3 grains of secobarbital had been given at midnight. The patient was showing the signs of both drugs: elation (LSD-25) and an unusual lack of motor and sensory control (secobarbital). D. CASE REPORT

A 40-year-old marriedwoman, who had come for psychoanalysis because of many psychosomatic adaptive and difficulties made excellent had progress (I). For example,relationships her two children with were markedlyimproved. Her ability to work had been restored with elimination of nearly all of her psychosomatic complaints, such as eczema, asthma, hayfever, headaches, and similar complaints. However, there were still some important problems, especially connected with her sex life within her marital situation which required attention, even though vaginal orgasm was frequently achieved with her husband. These sexual problems were mobilized by a dream about two dogs preparing for the sex act. Analysis of the dream was unsuccessful because the patient's anxieties overcame her usual interest in

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ascertaining the nature of the symbolic meaning of the dream. She said, "I am afraid of analyzing this dream." She had on previous occasions utilized LSD-25 to reorganize her defenses, so that in interviews lasting four hours, sufficient time permitted her both to reduce the defensive mechanisms and to reconstruct what was learned thereby to her psychic benefit. In the 50-minute interview ordinarily used, the psychic organization of this patient and perhaps of others is often left in a state more threatening to the patient than the patient can anticipate facing until the next interview. The patient soon learns to guard against this unprotected exposure. It is conceivable that with certain patients, particularly of the type presented here, that an analysis might take half the number of total hours if the interview times were doubled. In view of the satisfactory experience this patient had previously had in our interviews under LSD-25, it was decided to attempt to determine just what conscious and unconscious factors might be producing anxiety and the fear of analyzing the dog dream. In the following interview the nature of the anxieties connected with the dog dream were successfully analyzed by the patient, and a fear of homosexuality in herself which had been brewing but which had become intense was resolved. The verbatim recording which now follows outlines clearly a good part of the patient's psychosexual development which led to her confusing her childhood manner of relieving anxiety through masturbatory channels with later aspects of the psychosexual development, which both in the preanalytic and analytic frame of reference led to the patient's believing that she was a lesbian.
Time: Dr. half and Pt. 2:00 Now _.m. you've taken a dose of LSD-25 by mouth. You took it at about 30 minutes ago, /10 of an ampule of out for lunch. What did you have for lunch? sandwich and a glass of iced tea. LSD-25

past one, then went I had

a tunafish

Dr. How would you llke to start? Pt. Well, I don't know if this should go down but I think I somehow or other, for some reason, cause those seem And aware found sleep. though believe it here I anticipated few this I also, taking LSD, but more of what busy I felt rather concerned all week. I was rather

at all on the record, I don't think it's beI would for a few talk about. and days

days I wasn't able to have time to think about it. concerned, but I wasn't too busy. I felt concern yesterday, scratched my arm once, and of course

I didn't about it. was very

of it, and even though it went away. I found

it kept itching me I didn't scratch, and that I scratched my back mostly in my

I was pretty aware, also, of the fact during the week that alI knew I had dreams, I didn't remember the dreams. I really that I'm not a good subject that has, although I've discussed a good deal, I think anyway, perhaps not so much, but from

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the beginning of the analysis it has always been difficult for me to discuss sex in any way, about myself or anything else. When I did discuss it, or if I anticipated I was always very tense that after all this am able to enjoy the fact that I would before and afterwards. discuss it at a session, Although I realize

time I, well, I am able them more than I did,

to have sexual relations and there are some times that I

don't, or rather, not that I don't so much enjoy the relationship itself, but think about it seriously to a great extent. The one part about sex that still bothers me a great deal is masturbation. (Pause) What concerns me first of all is that time that John (husband) very often, very would go away often isn't the word, every I would find that I have

the desire to masturbate. It used to be much more than what it is now, in that there would be many times when I would be home during the day, when before I, oh, I would take a bath or a shower, well, anyway when I was going to take a shower, that often practice masturbation. And I felt that even though or something, I would very I had sexual

relations and enjoying them, that I still have this desire. It disturbs me very much. I was reading a book last night, a book called The Second Sex, and in it I, there was one chapter that was called lesbian, and I read that because even though we had discussed a good deal of this here, and you had said to me that you felt that I had enough feminine characteristics not to be considered a lesbian, I think I still have Dr. of the desire, the masturbation left a question in my mind. What question? whether do you now that I had mean you some characteristics, I guess you could say,

Pt. Well, a lesbian. Dr. Pt. What Well,

by lesbian? ask me the question, I realize To that probably always a me it was

my idea, my conception matter of, to the extent

of a lesbian is wrong. that I masturbate.

(It is of interest to _oint out that klaints of eczema, asthma, hayfe_er, been essentially eliminated, scratching

the patient's psychosomatic and other similar symptoms noqv occurring in connection

comhad _vith

the mobilization of anxiety over the fear of homosexuality.) Dr. Yes, but I didn't know that that was lesbianism. Pt. Dr. Pt. Dr. Well, You No. as I said, now that you ask me the question-would yourself. you? You wouldn't what call boys you're who masturbate doing, when homosexual, about

But that's

you talk

see, I'm not saying that you ties about your masturbation, that lesbianism ?" Pt. had I said the idea part that

shouldn't go ahead and but I am emphasizing, was that in going a man

discuss "Why

your anxiedo you call I always

of the reason sexual or

back I think would

relationship

with

be so satisfy-

ing that in time, would die down.

rather, after marriage, Yet it hasn't with me.

your desire to masturbate I think another thing that

132
has was enter to do we with were this,

JOURNAL when John

OF PSYCHOLOGY and I first time that started I ever having reached relationships an orgasm

before

married,

the only

through manipulation. the vagina, I never

And even really reached

though, afterwards he would an orgasm. And then, in time, really didn't feel when know that

I used to think, well, you reach an orgasm?

I used to question, how do you Could I think that I did, and

I had. And then I became an orgasm in one way, and

concerned because I only seemed to reach so I felt that although it was with a man,

and then in time, with my husband it still, well, it was still the same practice that lesbians use, which is part of the reason that, well, which is the real reason that I was concerned our home life became so strained, and using sexual relations as a weapon, about it. Then, of course when I came to the point where I was I was so unhappy that I had

when

no desire for them at all, that when I subjected myself to him it was such a strain that I became more concerned about it. As I started saying before, I started reading this book last night, The Second Sex, and well, I was rather sleepy when I was reading it. And somehow I just sort of remember this from it, that perhaps it does relate to me, in that it said something about a girl never getting past so to speak, where she does derive some sensation, except by manipulating the clitoris, and of course right to read it as I did. reasons as to why a girl about the relationship that the mother can That's [The very strange. statement, "That's _ery strange," refers to the effect The hour, o] this the clitoris _tage, some satisfaction, I probably had no

It also went on in some way as to the mental falls into well, into lesbianism, and it talked

between the mother and the daughter in two ways be overpowering, or that she can be a bad mother.

patient's

of the LSD-25 _,hieh *was taken approximately peak of the reaction usually occurs betqween but 1cries Dr. Pt. Dr. Pt. Dr. depends (2).] You feel Well-How? Yes. It was very strange? it? you to read that upon the symptoms studied.

#5 minutes before. the second and third See the i_rst paper

Do you llke all right for

book.

I think

you deal,

could and i

read anything you want to now. you might as well discuss what

You're going to read a great you read with me.

Pt. When I read the book, I sort of well, I saw myself as the daughter with the dominating mother, and I'm not getting away from it. I'm afraid I'm going to have to reread whatever I read about that because I don't remember, or perhaps I have to read back to get the full idea of what was in the book. It seems also_ that there are different situations which happened when I was younger, in that either I recall at times, and which I remember now. The first seems to be---I don't know if it's so or notqit seems that I remember the first time I ever had a sen-

HAROLD A. ABRAMSON sation of water on the clitoris, and how I discovered that it was a pleasant sensation. I can still picture the bathtub, I think, and the faucet, and how the water came out. And then I, of course, I recall one time when I turned around and found my father watching me; and I was so concerned as to whether he would go back and say something to my mother. And then, also I had such feeling about masturbation. I even became very superstitious about it, in that I was afraid to masturbate on a night before I was going to have an exam or something. The fear that it would, well, that God would punish me with different things, that something bad would happen to me that day! Dr. Where do you think you got those ideas from? About punishment because you had sexual pleasure? (This is the earliest sel[-stimulation.) recollection o/ a guilt /eelin in connection _oith

133

Pt. I don't know where I got them from. I could only say, possibly, from my parents, probably my mother, because my father never discussed sex. And yet, I can't ever remember my mother discussing sex either. I recall, too, that when I was younger, my sister and I always shared a room together. I used to think it was awful if she walked around undressed. I just sort of remember that now. I remember my mother even mentioning it years after. How I used to think it was so terrible for my sister to walk around nude! This, of course, was in our own room. I found, I remember also, that when I said that I didn't like, that I thought it was awful her walking around nude, I also found, if I remember correctly, to see her undressed was repulsive to me, and yet I didn't have the same feelings about my mother. I would often be in her room when she got dressed. And then it was my sister who explained the menstrual cycle to me and although she didn't explain it clearly I think I somewhat knew about it, because I had seen her walk around undressed. I think I was pretty annoyed with her afterwards, too. I was going to say, probably most young girls want to grow up and be like their older sisters, and feel that when they get to the point of menstruation that they're pretty grown up, too. But I didn't have those sort of feelings. (Lone /muse) To get back to my relationship with John, I had, oh, I guess you could say, a good deal of involved thoughts and feelings about it. I was just trying to remember. I wondered if, I think it was more or less, trying to find an answer of whether it was I who wasn't able to have real sexual satisfaction, or was it because of John that I couldn't. (Long pause) I don't know. Either I'm back again to the question of why do I think about having sexual relations previous to having them. That is, why do I think--not always--every so often, why do I have to think dui'ing an evening whether when I go to bed he'll want to have sexual relations or not. That's the main question. Actually, I'll end it there. Whether he's going to bother me about having sexual relations. Dr. But I understood that about your eightieth session you began

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to have orgasms correct ? Pt. time. Dr. Pt. Dr. Pt. Yes, But Yes. What I was but when

JOURNAL your

OF PSYCHOLOGY penis was in the with, vagina. it wasn't Is that all the

husband's probably

I would

say,

to begin

it would were very

happen? your happy; feelings I felt then? more satisfied. I should say more

satisfied with Dr. Well, Pt. Well,

myself. what interrupted I think one thing

that? that bothered me a great deal, the fact

that when we were living son of my neighbor, and gathered every sexual from what they time John relations.

in Boston, we got into a discussion with the they sort of implied, and which I think, I said, that they could tell, or they could hear,

and I went to bed together, and every time we had I was very much aware of the fact that the people that when can be.

underneath has always we have Dr. Pt.

us could hear us, and there again that's something bothered me a great deal, in that nobody must know sexual relations. It must be as private as it possibly

Why do you think that it must be as private as it possibly can be ? Why do I think I feel like that? Or, why do I think it shouldn't--

Dr. Oh, no! Why do you think you feel that way? Pt. The first thing I think about is the fact that I never knew, never once did I ever know that my parents ever had sexual relations. In fact, if I can remember, it was around the time when my father first took sick, I think, my mother mentioned something about my father not having any sexual relations because it was too much of a strain on him, ever when something like that. Which was the first time, had sexual relations, was mentioned to me. my sister started telling me that that ever, And then that they the time what had

she had told my mother

gone on between my sister and her husband, my reaction at that time was, what right have you to discuss that with mother? First of all, my feeling was, that she wasn't the one to discuss it with because her views were so distorted. By that time I was able to realize that. But even then I had the feeling that not o_ly shouldn't anyone ever know when you have sexual relations, but yo_t shouldn't discuss them with anybody. There was a time Ann, when I first noticed that not to say anything to her, or too, when I was also concerned she masturbated as a child, and draw her attention to it. I was about I knew pretty

concerned about it, because I thought this go on, as it went on with me? such feelingsas that[ Dr. You said that when you had

of it in terms of myself. Would And look how I am today, and

sexual

pleasure

through

masturba-

tion, you were afraid you'd be punished. You didn't know why. Now, as a little girl of eight or nine you hardly knew the meaning of sexual intercourse. You were wholly involved in sexual pleasure of self-stimu-

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lation. You had no real knowledge of the mechanics of sexual pleasure, but yet you were afraid that the Lord would punish you by making you fail! And you feel that no one must know, not the slightest implication, even the neighbors that you were having sexual relations with your husband, even though this was none of their concern, none of their business. Does that bring up anything? It might throw some light about your concern, about your husband approaching you. Do you think that the same fear that you had as a child, that you'd be punished, has left you? Pt. No, I would say that probably the feeling hasn't left me entirely, and especially I would say, the times when John approaches me, and it, it--especially at certain times, I think I still have those guilty feelings. Dr. They're guilty fears, aren't they? They're not alone guilty feelings, but they're guilty fears. Pt. Yes, they probably are the fears I had when I was younger, and yet it's hardly why. Those are the times when John and I, or rather I just can't explain to him, but when I feel, when there are tense situations. Let's say at the beginning of the year, when I was concerned about whether we would be able to get enough custom_ers and such, and was worried. It interferes with my desire for sexual relations. With John, that isn't an answer. One thing has nothing to do with the other. I think he can't understand how my worries about work can interfere with my sexual desires. Dr. But at the same time remember, you were always worried about failing at school. Are you carrying through your mother's ambitions for you at school? Are we still dealing with a fear of your mother, rather than a fear of your getting a sufficient amount of work to do ? It. Well, I don't know how much it has to do with my mother. Of course, it's---anyone wants to be successful. It's just a fear of not being successful. Dr. Yes, but those fears were put into you by your mother if we go back over your early years and see that that entered into your relationship with your husband. Not for you to be successful as a wife and a mother was the problem, by your mother's standard, but for you to be as successful as your husband. Why should he take the courses? Why should he attempt to lord over me? Whether his success was going to be reflected in your future happiness wasn't the point. The point was that you were first, according to your mother, who should solve the problem of your own security, if you remember. And part of that solution is cutting a man to size. Pt. Then I had a husband who turned around and said to me he didn't want a housewife, he wanted a business parmer. He wanted someone working with him. Dr. But at the same time he never rejected you in bed, did he?

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JOURNAL OF PSYCHOLOGY Pt. No. Dr. So, he wanted a woman in bed, but also someone who could function with him in a joint business. But as far as his own sexual instincts toward you went, they were certainly very active, even though you were helping in his work, or what turns out to be your joint work. He didn't only want you as a business partner, did he? Pt. No. Dr. So, I have the feeling also that you still have a fear o.f punishment that's coming in. That you don't succeed in what you want to do. I'd like to go back. I'm a bit confused. At one time I thought that your sexual feelings had improved considerably with John. Pt. They have, and you see, the way I know that sometimes they're greater than others, or rather, that they should be, well, that they could be more so; there are times when sexual relations with John are far more satisfying. The orgasm I reach is far greater than at times when I'm not as sexually stimulated. Dr. Women fluctuate a good deal. Some women are more sexually excited before the menstrual period, some during the menstrual period. Some require the absolute privacy which you just mentioned. Well, what would you say was the ideal situation in sexual relations with John? When you had all the sexual excitation which would be normal for you ? (At this point, the patient is beginning to be able to speak freely o[ the details o/ the sex act. This is undoubtedly due to the action of LSD-25 in a therapeutic situation. More than 300 intervie_vs _oithout LSD-25 may be considered as "control" inter_ie,ws. A four-hour session _vithout LgD-25 is not a_aailable, but from the _riter't experience, it is doubt[ul if this material could have been obtained in so timpie and direct a fashion.) Pt. There isn't any one time, that I remember in particular. I mean, I would say that I would remember a few different times when we, when I was excited sexually to the greatest that I've ever been. It couldn't have been much more; but you see, I think what bothers me more about it is that I would say I could probably number them, and one shouldn't be able to number them. Dr. What happened at those tlmes? Pt. Wellp at those times, I would say, first of all, that the duration of the act itself was much longer, and there was no desire on my part to end it. While we were having intercourse it was pleasurable the whole time. Well, instead of having the desire to have it end, as sometimes I do, I had the desire to go on indefinitely. And then, at the end of the act, I would feel exhausted, and satisfied, tired and relaxed. But then there are times when I can't wait until it's over. I don't want to begin. And I can't wait until it's over. Rather, I can't wait until he reaches an orgasm. And then I think, I don't know, I don't know if it's because it takes too long to reach an orgasm, or what, but I

HAROLD A. ABRAMSON think there were times when I hardly could, before I have an orgasm, so that when he's finished, I don't feel completely satisfied. And then, you see, I'm afraid to tell him. First of all, I used the word a[raid to tell him. I guess I am afraid to tell him that I didn't reach an orgasm. I used my childish masturbation for sexual satisfaction. And after this continued for a while, was when I started to question, what is an orgasm? Am I capable of reaching an orgasm, with the penis in the vagina. It got to a point that I couldn't reach an orgasm that way. Dr. I understand that you did, later on in your analysis. Pt. I'm talking about when I was first married. I think that fact that I still, well, that I still desired to have him manipulate the clitoris, I still had a desire, although there are times now when I don't. That the desire is still there still bothers me, because to me, it's that I haven't really grown up, that I'm not able to have sexual satisfaction or relations in an "animal" way, that I still feel a child's way of masturbatingDr. Is that lesbianism? Pt. Well, having the desire made me feel that it was. (Rest Period--ten minutes) Dr. Let's see; the time is now 3:15 and you've had LSD an hour and forty-five minutes ago. How do you feel? Pt. I feel drunk, like when I get drunk from whiskey. Give me one drink or two drinks and I feel happy and gay and sleepy. Dr. Are you aware of everything that you're talking about? Pt. I know everything I'm saying; I know what I'm doing; and I probably will remember everything. Dr. Can you think dearly? Pt. Yes, I can think clearly. Dr. One of the things I think you ought to talk about now is about the great, well, say fear, you had in discussing your sex life with me recently even though we had gone over a great many of these things before. I wonder if you'd go into that. What the nature of those worries were! Why you didn't want to talk about it; or why you were reluctant to talk of it. What do they mean to you? Why did you feel that way ? Pt. I think, probably, first of all I think I was afraid to talk about them is the fact that, well, I've had these fears about myself, I think, for a long time. Something I had kept to myself for so long, too, and not talk about with anybody. I never had anyone whom I could talk, turn to, and if I had a question about sex, get an answer. And yet, I remember before I started the analysis, that was one of the things, when I was thinking about the fact that I need psychiatric help, that here was somebody I could turn to and ask these questions and get an objective answer. And yet when the time came I couldn't do it. And even while I was thinking about getting psychiatric help I used to think that maybe there is a family doctor I could go to and ask questions

137

'

l._ and find out about

JOURNAL OF PSYCttOLOGY myself. When I, I never, I guess I never had enough

confidence in any of them to do that. And then when I started the analysis it was easier for me to talk about my mother, I guess, and I found her easiest to talk about first. And then I think I got to a point where I was I not only had the fears afraid to find out what about myself, I feared was but a sexual true. point where

Dr. Were you also possibly afraid that I would think less of you, or that I would punish you in some way or other? [Early in the patient's analysis, her method of a,taHation to the therapist _'as similar to that or,filch she emfMoyed to_:'ards her mother. This turned out to be an adwantaye (transference neurosis) in the analytic procedure.] Pt. ning. Well, that you thought less of me, yes. Especially in the begin-

Dr. Remember, as a little girl you were afraid of being punished for having sexual pleasure? And as a little girl, your fears were not connected with being a lesbian, whatever that may be to you. But_ it was a fear of punishment! And you think your concern about talking to me about all of these things were not only concerned with yourself, but that in some way I would be a punishing parent. It. In a way you assumed a punishing r61e, yes, because, was more or less like the rble the teacher had when you're well, it younger.

Or in some way it looked to my mother, that you always had to be good, always. Well, by discussing these things with you I would, well, lower myself and so by lowering myself and your looking down on me would be a punishment to me, because I was always looking to be the best in the class with the teacher, the favorite. I remember when I was being confirmed, deal of involvement because year deal and I guess, I remember there again, too, was a great the time, through that whole

of being trained for confirmation and everything, I strived a great to be the best in the class. I guess for two reasons at that time.

First of all, because I wanted a certain part, a certain speech in the confirmation. My sister had that speech, and I wanted it too. Then also, I don't think this is too soon after the business I had at Sunday School where I lied about the teacher and I was so very much afraid of that, and it wasn't, I can't remember exactly, it was Dr .... ,! who came up to the house that time, and the teacher, and it was more or less my being the best in the class that time, and redeeming myself too, to prove to him that I was very smart, I was very good. It was also at this time that I had a great deal of confidence in my social relationship with boys, and I had a great deal of trouble with my mother at that time. I remember that was around the first time that I started getting eczema on my forehead. I had a great deal of pressure from my mother at that time, about having dates, this one being popular, and that one being popular, and my not going out. It was all through this time too, that many times I went out of the house and said I had

_*

HAROLD A. ABRAMSON a date and that didn't have had one. the Even desire if it was before with a girl! the It's very funny to be

139

I should

have

I started

analysis

able to come and discuss myself freely, I thought, time came I just couldn't do it. As I say, I never of discussing sex with anybody, could turn to and ask questions Dr. (The though How much beneficial in a sense,

and then when the had any opportunity was anyone I

or feeling that there and get an answer.

difficulty are you finding now, talking about it? effect o[ LSD-25 is noqv especially portrayed, the patient same is a special case in a psychoanalytic type of production of material

allduring

situation, I ha,e seen the brief therapy *with LSD-25) Pt. when tion

Today, I don't feel any difficulty in talking about it. In fact we had the break, and I started thinking that this was a big questo begin with, a big problem to begin with, and unless I come out unless something or to not know comes out of this today, that to not have the where to go from here, as to my sexual relait's my feelings after four years about about it that, well, I certainly must be this too.

of, well, answers,

tions, and my sexual force, actually, that I've had four years now, and at a point where I am

able to do something

Dr. Well, you just pointed out that that was cult things for you to talk about. You also pointed of talking about the things your mother, that that was that would Pt. Dr. rather Pt. myself time, more really were on your disturb you. Isn't Yes, that's right. So would you say than four years In part. There into discussing

one of the most diffiout to me that instead

you went to analysis for, you talked about easy. The things that really troubled you, you very right? had four years of avoiding or rather at problems force the carefully avoided, because they that

mind,

you've

of facing things? are times when the parts that

I deliberately, very

I found

distressful

and yet I was able to do it. I think probably what bothers me right now is the fact that after four years I still found it, and up you could say, so straining to come in and talk I had a time where I really eagerly discussed. I times when It's always couch), I probably been such became have spoken more or less a strain to say everything too anxious to speak You to sl_eak sitting walk up. up freely See and

until today, I guess about it. And then think there have been freely, but not easily. that's , (The patient, and was asked Dr. if sitting '

been on my mind. lying on the to sit up. can speak

I'd like you to sit up, it's easier up you even more

for you freely.

can

down, or anything. For example, you want to take up the dog dream again. or should you wait? (The "dog dream": ]rankly 50-mlnute said she could intervie_ t_ao dogs not freely _without

mentioned last week that you Should you take that up now, intercourse. dream in the The patient

lzaolng sexual discuss this

_receding

LSD-25.)

140

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PSYCHOLOGY

Pt. I think it's a good time for me to take it up now because I'm pretty relaxed now and there's a great deal of feeling abo,ut that dream. When I think about it now it had, the dream, first of all when I first started thinking about it afterwards, I started, it started the problem again in my mind of, does this concern my feelings again about being a lesbian ? And, you know, I feel silly saying it now, because as I talk about it more and more I see how foolish, well, it's mcwe or less like perpetuating the first thing that I ever learned about lesbians as a child and this just continued in my mind, this conception, and that was it. Although I knew more about them, or rather had learned more about them in time, still this old conception remained with me, so when I thought about it in relation to myself, it was still there as it was when I was a child. It must have been a very great fear on my part of being a lesbian, in time, as I grew older, because probably I would say, that I didn't understand when I masturbated at first. To me it was just a pleasurable sensation. I didn't know it was masturbation. Nobody ever discussed masturbation with me, nobody ever said anything. And so I think probably perhaps it had something to do with the fact, as I remember now, that v_hen I first learned about lesbianism I sort of connected the two, my masturbating and lesbianism, and the two remained the same in my mind. (The follo_'ing vi_idly ]_ortrays how the little girl laid a psychological foundation [or identifying masturbation with homosexuality.) Dr. Now I have an idea. Do you remember what happened before you started to masturbate with water? You saw something. And your fantasies when you masturbated followed a certain pattern which might hook it up with lesbianism. Can you link the two together ? What were your fantasies before you masturbated? The things that excited you sexually? Pt. Yes, I saw my mother taking a douche. Dr. That's right. Pt. I thought she was taking an enema. Dr. That's right. You actually saw the tip going into the vagina, didn't you ? Pt. Yes. Dr. And then-Pt. I didn't realize it was the vagina at the time, though. Dr. But nevertheless that's what you saw. Pt. Yes. Dr. And then you told me that you had certain fantasies that would get you excited sexually. And then you'd masturbate. Do you remember what those fantasies were? Pt. Yes. Dr. Pt. Tell me about them again and see if you can make a correlation. It was--I don't remember. (Pause) Would you like me to

Dr. Try to remember if you can. tell you ?

HAROLD Pt. Yes. as I recall,

A. ABRAM$ON"

141

Dr. Well, rectum. Pt. Yes. Dr. Pt.

you visualized

something

going

into your

own

Remember Yes, the

that? thought of an enema would excite me. excite you. girl your So not

Dr. Yes, that's right. The thought of an enema would you talk about that. If you can visualize as a little knowing the difference ing a clear knowledge area was an erotic between a vagina of the physiology, an area where

and a rectum, your but just a knowledge a great deal of sexual

not havthat that pleasure

area,

was mobilized, and you had seen your mother-Pt. Who slammed the door in my face .... Dr. Did she do that? Pt. Dr. It was Yes. then, So after that point, was that also I had a so much feeling about Had it. your this feeling sexual feeling.

mother given you many enemas? Pt. Not that I remember, no. Dr. Did you visualize your mother giving you the enema when you got sexually excited? Pt. I guess, yes. Dr. be that pleasure It was your mother then, giving you this sexual pleasure. Mayof sexual produced is the correlation was lesbianism, that made you think that this form because it was sexual excitement

by a woman. As you put it, your mother family. Could that be the origin of your misconceptions which you held giving right. on to? duced by a woman into you. Pt. Dr. Yes, Yes. that's you an enema, Those what were you

was the powerful one in the misconception? The childish sexual excitement putting at all was proby a woman something about--

Your

my first feelings as lesbianism?

So, that's

define

Pt. But then ably after this, member that

I remember I got to a point where my feelings, probbecause, I don't know how soon afterwards, but I reor at any time after want, want that, that the thought of I was afraid, in a way. my mother to do it, for was the way

at one time,

my mother giving me an enema, I didn't No, not afraid. It was just that I didn't some reason or other. Dr. Well, you can see the reason in which you got sexually stimulated. Pt. Yes. Dr. ' do you Well, think? LSD-25 reaction, and simultaneously _.vithout like this now I think we've solved

now. Because that Is that correct? the puzzle

of lesbianism.

What

(At the height o/ the to integrate many [acts, ously Pt. _vas unable It's so funny,

note how the patient is able bring up data she pre_ianxiety.) be, I mean, these inshould

to discuss

o,erqahelming

something

142

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cidents. I can remember that I talked about them a long time ago, and each one of them was of individual interest in my mind, and yet there are only a few things that happened around that time and in that apartment that I remember. And there again, too, was the time when I thought my mother was gone and I thought _omething had happened to my mother, and I prayed to God, and I was crying so, all afternoon, because I was afraid something had happened to her. Undoubtedly I had a great deal of feeling at that time, and yet it took me all this time to talk about it, about them altogether, because, after that one afternoon when I said to you that I was always afraid of being punished by God when I masturbated, because after that afternoon, I remember I'd always felt that by getting down on my hands and knees and praying to God that he would help, because of that afternoon. He brought my mother back. And so I always have this feeling that he could punish me at these times, and also that he could be good to me. Dr. Do you prefer sitting up or lying down? It. I'm comfortable. I think I'd rather sit up. To get back to the dog dream--though, first of all, I thought of this before and I just recalled thinking it again, that I think one thing that I never had any satisfaction, or any feeling good about, when I used to dress in front of John, instead of feeling confident of the fact that I could, that I stimulated him in any--sexually, instead I used to feel kind of annoyed _r embarrassed, and then, for so long, when I used to get undressed when I first came here, even, as soon as I started taking off my clothes I'd scratch so. Those were the times when I felt itchy. The dog dream, to get back again to that, it's somewhat of the same thing, somehow with that dream that even though in the dream I expected the dog to fight with the female, instead of really mounting her in the dream, he was licking her. And though I kept waiting for him to mount he never did. He just licked her. I said before that the questions that I had about John also just as an individual, I guess part of it, I guess one of the questions that I had--(Pause) That's another thing, too, because I guess, actually, when I think about how I derive my knowledge of sex, I couldn't tell you that I ever read a book, or that I did this or that. It's just, it seems where most of it came from, I don't know. Most of it even came out of my own mind. There wasn't too long ago that I, oh, I guess a couple of years before I was married, no, I don't even think that long, maybe a year before I was married, that I =ame across the word cunnilingus in a book, I think that's how you pronounce it, that I looked it up in the dictionary. I don't even, I don't know where I got the idea from but to me it was a, this is the wrong thing to do, too. I don't know why I think of this. Just about a week or two ago I thought of this too. I used to go through my mother's drawers when she was out, oh, I think up until the time when I left home, and in going through her drawers, I came across the books which I mentioned here before. They were, I guess, supposed to be

|_ I! I _

HAROLDA. ABRAMSON

143

French books. One was a story which had lesbians in it too, I think. And the other was a book on the different positions to be taken during sexual intercourse. These two books were hidden in the bottom of the drawer, and I never mentioned it to my mother until, not even, oh, I think it could though. And even have been after my father the other day I just realized, or died, pretty recently I thought of it, was

mother denied them at the time, said she never had them. It only struck me very funny at the time that she should deny it. I mean, at this late date. that when we cleared out her drawers those books were gone. My Dr. Well, about sex. Pt. great deal. maybe she was my mother I know embarrassed. had that a great she had Maybe deal such of she fear also about had fears A But very time off?

Oh, I think Because

sex.

distorted

views.

from what she said to my sister, I know that her ideas were strange. I probably derive some of them from her, I don't know. Dr. By the way, it's about Do two you and still a half feel hours from the you've taken the medicine. Do you feel as high? Pt. Not headiness. Dr. Yes. quite as high. Is it two and Why? Did it, or (Laughter) shorter? is it wearing I feel

I'm getting more, a half hours? the time seem

a slight

much

Pt. Well, when I looked at the clock before, I just remembered now I didn't realize it was three o'clock, or that the time had passed so fast. I couldn't remember why timt meant so much to me. Now I remember that the last time we talked about the fact that time goes much faster than what you realize. (Time o/ten appears to pass much [aster ,while under the influence of LSD-2S. This /acilitates a /our-hour interview /or both patient and therapist.) Dr. When This time you implied we previously analyzed So it's just has worried worried that that John the dream was we the said dog in the dream. that you were the about John's

dog in the dream. masculinity, which Pt. Yes. Dr. cause Pt. ] ] Are you

as if you had reservations you a good deal. you're not very much of

a female

besuited

you married John? Is You see, before I said

that what's really bothering you? something about are we perhaps

for each other because he is not as masculine and I am not as feminine. Dr. Yes, but do you think masculinity and feminity can be measured like a yard of cloth. Pt. I guess I'd like to. Dr. You rive sexual tasies Pt. see, you pleasure haven't ever shown any from a woman, although important in your desire to dechiidhod fanstimulated you.

it was your mother with a symbolic penis who Yet I felt very repulsive towards my mother.

144

JOURNAL OF PSYCHOLOGY Dr. Yes. Well, that could be a compensation for your sexual excitation produced by the all-powerful figure in your home, the mother. And your mother with an enema tip in her hand, symbolically, could have frightened you. Your mother was a frightening person. And that very sign of strength would appeal to the feminine core within you. Pt. Yes, I just remember now, too, I remember playing with my dolls. I would play that I was giving them an enema. Dr. You were placating your mother, symbolically; you were a good little girl. She expressed her masculinity not only towards your father, whom she regularly castrated, but also towards you, whom she treated as a female, in your own symbolic thinking as a little girl. Your r61e has been essentially feminine, although you've been trying to placate your mother, living up to her idea of what a feminine woman should be like; in other words, someone like herself. She really tried to mold you in her image. Pt. Then, in other words, as I said, I always kept my childish conception of a lesbian, even though my knowledge about them increased with time, so that actually, what I have done is that somehow or other I have taken physical reactions and disregarded my mental ones, in my thinking, and disregarded that completely and taken only my physical reactions as being indications as to whether I am a lesbian or not. Dr. What do you mean by physical reactions? Pt. Well, as I said before, the only way John ever excited me when we first got married, was by manipulation, and to me that was just a physical reaction. Dr. But it was not lesbianism, which is-Pt. No, so I had taken purely my physical reactions as being a guide as to whether I am or not, and disregarded whether I ever had any inclinations or dreams or feelings towards a woman. Which I never had. Dr. Now, in this dog dream, you're really the female, aren't you? It. Yes. And I'm waiting to be mounted, that was my feeling. Dr. Now, you've analyzed the dream. And yet you tell me that your husband is willing to do that whenever you wish. Pt. Yes. Dr. So ? Pt. Which has always put a question in my mind about him. Dr. What question? Pt. Well, in that he is always ready to, well, to satisfy me sexually in any way that I wish. Dr. What's wrong with that? Pt. Well, I thought it was wrong. As I think about it more and more, I feel it was wrong, or I thought it was wrong because I felt that what I wanted was wrong, that he wanted to do it was wrong, too. Dr. Wrong? Punishment again involved? In other words, you're saying it was wrong to have pleasure, sexual pleasure. It might not have been the most mature relationship, but I don't see anything wrong.

HAROLD A. ABRAMSON Pt. You see, when you said just the two words, sexual pleasure, I thought also of, yes, I think I was afraid, and sometimes I am afraid to have sexual pleasure, because I think of the time when I went with my friend to see the sailors and my mother found out and she spit in my face and called me a dirty tramp. To me, to have a desire to see a sailor, it was sexy, it was dirty, it was wrong, and my mother spit in my face for it. It was a horrible thing, and so I, also the idea that I was oversexed. I had all sorts of fears. Dr. Of fears, which your mother injected, which you don't need anymore. Pt. But why, I mean, as I think now, the times when I have said that I had the greatest sexual pleasure were the times when I was probably least inhibited during the sex act. Then what causes me to, why do these fears at times come out more than others? Because of the influence of my emotional feelings at that time? Of different influences upon me? Dr. Your analysis is concerned with metamorphosing your fears of your mother and her dominance over you, and your understanding of those fears, getting rid of them, together with the guilt. Pt. And I've had more trouble lately, since I'm back again in her house. That's one thing. Dr. Yes, that's one thing. Ever since you're living in her home your fears have been again mobilized. You want the reassurance of a strong character like your mother. In terms of your mother, your husband isn't a dominant male, because he does what you wish. He gives you sexual pleasure the way you want it. Yet you describe him as being pretty aggressive. And yet you can't accept him because of the threatening nature of his being superior to you. You're afraid of what would happen to you, that you will become a passive female. You're afraid then that you'll lose him, which your mother established when you were a little girl, "This is what I want my little girl to be, she's got to be like me." In your first session, or second session, you were afraid you had cut your husband to size, too. Pt. Yes, there's a great deal of conflict in my feelings towards John, sexually, because in a way I want him to be the aggressor, and yet when he is the aggressor I am annoyed, also. (Laughter) You see, it's true, whatever I have said here as to my sexual relations with him, or in whamver way I've spoken about sex, I've always made it as honest as I possibly could at the time, or if I told yc0u of an incident it was true, because I realize to lie would be foolish, I mean, I'm not gaining anything by it. Either don't talk about it at all, or tell the truth. And yet, I realize now, that I've been quite concerned; I think my concern has turned more to sex again, in my relationship with John, because it wasn't what it was before I moved into my mother's apartment. I realized it, and I guess $'ou might say it gathered momentum until it reached a point, until I couldn't stand it any more.

145

146
Dr. That's why

JOURNAL I thought

OF PSYCHOLOGY it was a great mistake for you to live in

your mother's apartment; Pt. Well, you know, And to tell in the chair,

to be with her things, with her clothes. the tangible things are very easy to get over. I just realized before when I made over for my mother, I was sitting although she

you the truth, too, the dress

never wore it, it was my mother's, of the clothes now and not think a pair but, oh, of gloves the once in a while as tangible things

that I made over. I can put on most too much about it. Oh, I'll take out and think saying, that you it was can my mother's them get over

I started

much easier, you're aware of them, they're it's the intangible things that you don't see, Dr. That's what It's psychoanalytic not the dress, theory but the tangible things. the dress. Pt.

in front of you. You see, and you just don't realize. with. that Feelings you have are infeeling about

deals

[Corn#are owith Kinsey's I wonder now, what I think by staying there, but

discussion (11, #. 170).] I was, what I thought I was that I had something

going to con-

to conquer

I thought

quer by living in that apartment and living through-Dr. You had someone to conquer, instead of something. Pt. It wasn't my mother I wanted he. to conquer. Because method by of It was conquering operation, either him John I was it? or myself. And I think sure of the results. Dr. Pt. Well, Yes. that was it was your

mother's

wasn't

Dr. See, all of your discussion about John in the last few have been tinted with the notion that he wanted to be successful. you couldn't Pt. And nately, there times success take. In other words, that he was successful they're not pure his successes were your without me. (Pause) I could say that

months That

failures. Unfortuthere again,

though,

feelings.

was a conflict when I want could be my

with him. Of course, him to be successful, success, too.

I could say that there were because I realize that his always the idea that with his alone. that what

Yet it was

his success I must have a finger in it also, that it isn't purely Dr. But he wants you to l But he gets the glory. Isn't bothers you? Pt. Yes, that's Dr. When member ? Pt. Yes. you whatbothers went me. of Trustees meeting,

to that Board

do you

re-

Dr. He was you weren't. Pt. more aware But, you or of less, mine

moving see,

into

the

upper or less I he's

echelon taken think, taking he ioins

of the

policy-making step though, I am that

and in that,

I have ,more

I think this

unconsciously, well, for me, and want

though

sometimes way, and and I and

it, I am sometimes, way, organization

his step him,

I'm taking join that

this organization, so to speak,

and I don't

to he with

HAROLD

A. ABRAMSON

147

a member of an organization or all for me alone, because Dr. Pt. always Why not? I could answer had the feeling

with him. I, it must be all I can't share with him.

for him

alone

you very simply and say that I, because I've that whatever my father was and made of himMy mother was the one who himself, along in the business pushed world, him let's

self my mother helped him. into taking steps to further say. John.

I don't, you see, I haven't been able It still is this idea that I'm working and have not gotten the glory your that recognition. precisely what always told that. you

to gain that feeling yet with for him, or that I have done that always look he gets told out the name, you

so much

I want, mother you

that he gets the Dr. But that's must do. She And you're Pt. Yes,

you that for

must

yourself.

still doing I am.

Dr. You said about 20 minutes ago that that his success was also security for you. Pt. Dr. Pt. Dr. Pt. Dr. Pt. Oh, yes, I can realize that. But Emotionally though-I've got to have-It's threatening It's threatening? to you.

you

realize,

realistically,

emotionallym

Yes. You say that-Because he has what I want? and 10 minutes after you've

Dr. Yes. (Pause) It's now three hours had the medicine. How do you feel now? Pt. Dr. Pt. Dr. Pt. Dr. Pt. I had analysis, was that I still feel lightheaded. feel Not you as much can talk Well, do ynu still Yes, just as free. Now, I can All you've repeat right, go been some right

as before. about things?

sitting up. of the things ahead.

I said

that

we

missed. that in that

While you were out I was when I gave the conclusion and when that I asked I knew

thinking when I had the question to what I thought I accomplished "Where that do I go from I came in with and

the question, of

here?,"

the one big problem

I had not really gotten to the point was sex. And that I was questioning really. Dr. the band. Which Do you is also was the recall borne that? out that of

discussing freely or easily yet, what am I going to do about it, sessions relationship I felt following with was the much your of hus-

in the your what

material

discussion

So that's sessions are the medicine I feel

problem.

You'll remember cussion. In what more Pt. freely Well, ?

that those way does all,

earmarked by that type of diswhich you took make you speak when I'm talking at all,

I first of

no tension

148

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OF PSYCHOLOGY

and I just go on thinking and whatever I think I feel free to say, which I never feel, usually, especially when I'm discussing sex; I don't feel free. Dr. Your mother didn't feel free to discuss sex. She hid the books which you mentioned. Pt. She hid everything. I mean, sex just wasn't a word that was said in the house, and when it was said it was a dirty word, it just wasn't used. It was either a sexy person, or a sexy book, or a sexy joke. It was used derogatorily, not in any way of speaking objectively or any other way about it. Dr. Then, in a sense, I think another point is brought up. You were brought up to feel that if you're married to a man who is always ready to mount you, so to speak, it was a derogatory situation. Pt. Yes. And you were just as derogatory by letting him do it_ Dr. Yes. Yes, and that might account in a very definite way for some of the feelings you have. Pt. Yes, you see, there again she really put conflict in me too, I guess: well, she more or less told me that the wife submits to the husband sexually, but you control, in a way, the number of times, or in some way or other, the wife is the controlling, and yet submissive at the same time. You submit to sexual relations, but you're still the controlling factor of it. That is, you are the one who says what he does and what he doesn't do, more or less, which she even told my sister. Dr. So the only way you have complete control of your sexual life is to masturbate. (Judging /rom Kinsey's report, it is hardly likely that the psychodynamic significance of this point is understood by Kinsey and his co,workers.) Pt. Yes. And yet I don't feel control over it, because, well, that's probably why I have so much feeling over it, because well, thatm Dr. When I say control, I mean control of your sexual life with your husband, not control of your sexual life. Pt. Well, that's what I mean. I don't, it, I do think about the fact that if I masturbate it might kill my desire to have sexual relations with him. It also enters my mind too, that I'm satisfying myself alone, and am I going to be able to enjoy sexual relations with him. And that I don't want either. So, I have so many conflicts about it, about the problem that I guess I-Dr. Well, now you see all these conflicts, and you see their origin. But it isn't enough to see them. You have to make use of the insight which you have. Pt. I think I can, because I think of the little, or anyway, of what I have discussed here before I have been able to use. Probably if I had been able to speak more freely before about this, perhaps I would have gotten over this big hump sooner. Actually, by this discussion today too, I think first of all, just the fact that I'm able to discuss it

HAROLD

A.

ABRAMSON

149

freely is one big thing to me.

that gin have been answered today.

And then there have been many questions

Because I guess, I, by letting the ori-

of why I have such feelings or thoughts, and by understanding, I think the need for some of it will disappear too, in time. (Pause) [ was just thinking of an incident when my mother was in the hospital the last time and she was pretty sick at that time. My sister was there, and somehow or other, as my sister said, I don't know how, sick as my mother was, she just sensed that my sister was having her menstrual period and said something to her about it and you know, when I think about it now, it just sort of, the same way that sex always was all my life, with her, and yet I know that my feelings and my thoughts or whatever I was thinking about sex, were gotten from my mother, the unspoken word, nothing has to be said, she just somehow got it across to you. (Pause) You know it's, before I came here today I knew too, that this was what I had to discuss here, part of what had to come out and, oh, I guess I was wondering away whether for four years I had sort of side-stepped the real question, the real basis of what I needed the analysis for. I think it's all part of the picture of my relationship with my mother. I think I did side-step it at times, but I had always side-stepped it all my life, I always had to. And I think by her dying, more or less, well, in a way, I was going to say at first it stopped me from talking and yet it didn't. As a fact, it really brought it to a point, a climax. I really had to do something, about the one question that was still bothering me so greatly. I have one question I must ask you. How can you remember after such a long time, such a simple point of the one thing I told you about, about walking into the bathroom on my mother when she was taking a douche ? Dr. How do I remember it? Pt. Yes. I mean, I've said so much in four years. How can one point he remembered? At different times I have thought this also. Dr. It was a very important point. It was important enough for me to remember, to keep in mind, in connection with your problem. Pt. Oh! Because I know I talked about it a long time ago. Dr. Yes. But you said following that incident you had begun to masturbate, and then about two years later you were able to discuss the fantasies you had in masturbating; and now today those fantasies became crystalized and their meaning became clear. But it was very important that we know, that we both kept in mind what had happened just before, in connection with those fantasies. Pt. I didn't recall it in sequence though. I didn't remember the fact that I started masturbating after that. I don't think it meant as much to me at the time-Dr. That's to be expected, that you wouldn't make those correlations. Pt. I remember there was something else-Dr. You brought up the fact in connection with the dog dream that when you took the dog to the veterinarian that you got some hayfever.

150

JOURNAL OF PSYCHOLOGY Pt. Oh, yes, that's what I wanted to say. Yes. I sat there for about, this was last Monday, I was here last Monday, I took the dog to the veterinarian in the afternoon and I was in there, oh, less than five minutes, Dr. Were and I started sneezing, there many other dogs oh, terribly! around?

Pt. Oh, yes. There were dogs and eats there, too. I would say that (laughter) I was emotionally upset at the time, and I realize that I was. Or rather, I'd say that at first I didn't, that at first I blamed it purely on the fact that being at the vet's, so much dander and everything around, and I was pretty bad off. But then it continued after I left there, and the next day too, I think I was still sneezing a little bit, and by that time I realized also, I was and and rather concerned at the fact that well, that I was coming here I had kept in me for so long, a very good combination, toms of being extremely Dr. You were giving Pt. Dr. No, I just Oh, I see. took him that I was going to discuss all that I realize that the two together make symp-

so that I had very good physiological allergic to animals. (Laughter) the dog away, weren't you? for an injection.

Pt. (Laughter) But I had a very difficult time explaining to the vet how I could live with a dog and be so allergic at the same time. Dr. It could have been the cat dander. Or it could have been the insecticide. I quite agree with you that the emotional factors are important, but I also believe there was a good deal of dander around. It. Oh, yes, but I mean, I would say I could have had some reaction to it, but I think it was because I was emotionally upset at the time ing. Dr. too, that My nose The it had only way so much all effect. find My up. out is for you to go back and see eyes were all swollen and tearbecame clogged

we could reaction. do.

if you get the same Pt. That I could Dr. Pt.

If you're interested go I'd be too much aware

ahead and do it. though, I think, I mean

it would

be

so

purposeful. Dr. Well-Pt. Dr. Pt. Oh, I've been there-Oh, you've been there Oh, yes, I've been before? before. that I was there. To his place,

there

Dr. During Pt. No, this that is. Dr. It. been Dr. Pt.

the pollen season? was during the winter

You've never been to his place-I've never been to his place during to the Oh, Yes. vet's you during have the pollen season. been?

the

pollen

season,

but

I've

HAROLD A. ABRAMSON" Dr. Last week there wasn't too much pollen in the air; tween tree and grass pollination. it was be-

151

Pt. $o, I mean, I have been to the vet's before, during pollen season. I know I take the dog every spring for a rabies injection. And I never had this extreme reaction, that I could remember. There was one time when I came back and told you about it. Of course, I still get hives when I touch a dog. Dr. I'm inclined to think that you-Pt. I can't pet him-Dr. Sensitivity to dander-Pt. I mean, right where I touch him I iust come right out on my arm with-Dr. I agree that psychological factors are important; but still, it's surprising that you can live with a dog. You get hives when you come in contact with his saliva? Pt. Even his skin, if I just pet him. His hair, I get the hives from that. Dr. He must have saliva on his hair. Pt. He could because he licks himself a good deal. I think it's more his saliva than his body. Dr. Yes, I think so. Pt. (Laughing) And yet I hate to talk about that because my mother always used to say that she was allergic to dogs. Dr. Oh, your mother was allergic to dogs? Well, that changes it a little bit. Pt. (Laughing) And she always started scratching after a dog licked her. I think, I mean, I think some of it was a little psychological, also, because she always scratched, but she couldn't stand the saliva of a dog. Dr. Now, do you think we've gone over enough ground? Pt. I think so. (This concluded the psychothtrapeutic interview. The patient was accompanied home by a [fiend, and [elt well and slept well the next day. Her ability to integrate effectively new analytic material persisted ]or at least 10 days. /ls mentioned in the ]oregoing, she lost her [ear of homosexuality and the anxiety which had been mobili_ed by the dog dream.) E. DIscvssIor_ According activity by Moreover, frequency to Kinsey means of and his co-workers, which the female masturbation is a type of sexual most frequently reaches orgasm. that after it is the marriage significance second in order for the female. of the masturbatory as a whole. We o{ In

their data provide evidence of sexual activity before and case report, in connection with

the foregoing act is portrayed

the psychodynamic

the life of the patient

152 have seen that masturbation

JOURNAL

OF

PSYCHOLOGY

may produce

an extremely

complicated

pattern

in the life of a married woman who had also achieved orgasms with her husband. But life with her husband plicated by her masturbation. )'Iasturbation, therefore, sexual anxiety parents. connected pleasure, that but a quasi-autonomic had experienced technique of the patient in childhood

satisfactory vaginal was especially comwas not a source of relieving the type of in relationship to her

Psychodynamically in the following

speaking, scratching way with scratching

and masturbation are here and eczema which began

in infancy. The threatening relationship child retained, for all practical purposes, life. This eczema, together with the early age when the prototypes of later child. The reaction of the child and and violent infantile reaction on the only object the infant adult with persistent life situations; their fantile form constitution. guilt adult

of the mother (parent) to the her infantile eczema into adult relationship, began at an feelings were developing in the was characterized by a simple parent by a retaliatory attack It is thus that the allergic certain threatening daily by a persistent and inprepared by an allergic

threatening

to the threatening can attack--itself.

infantile type of eczema meets threatening nature is matched in areas already

of retaliation--scratching

The little girl grew up, therefore, condition as one of the devices which relationship with her parents,

with scratching, itching, and a skin she used to maintain a less threatening with her masculine mother who

especially

"cut a man to size." As the little girl passed through the Oedipal situation there was no feminine woman with whom to identify, but only a threatening phallic mother. Her adaptation to the male at this period was characterized by contacts Although tion during with data are the passive father who had been effectively that "cut to size." manipulathe little not available, it is conceivable accidental stimulated

bathing

by the mother

may have erotically

glrl so that she found an important source of pleasure in her relationship with her mother. Her special technique may have been produced by the accidental sexual observation was of themother achieved taking by thinking a douche. of the In childhood mother inserting fantasy, somestimulation

thing in the patient's rectum, such as giving an enema. bolically resolved in the analytic material by achieving turbation in a special way--by water. The water tap, but also symbolically and thus participated It was only through record symbolic that the homosexual speaking, through the enema

This fantasy is symorgasm through masout through the tip held by the mother

streams

in, in toto, by the phallicized mother or mother-symbols. psychoanalysis of this pattern as given in the verbatim was able to eliminate in her daily the life. concomitant fear of this relationship

patient

HAROLD

A. ABRAMSON

[53

One wonders if this psychodynamic approach is not more important than that emphasized by Yerkes and Corner in their preface to Kinsey's book ( 11 ) : Comparison of Freud and Kinsey is not implied, for the two men differed greatly in temperament, professional training and experience, and in their objectives; but what should be noted is the fact that Freud, on the basis of his clinical experience, proposed theories which laid the foundation for a task he was not fitted by nature or training to carry on. This is the great task of fact-finding through careful, patient, longcontinued, objective research which Alfred Kinsey, the laboratory- and field-trained biologist, is now engaged in doing. From the Kinsey project, sufficiently extended, should come basic knowledge of sexual phenomena against which theory may be checked, modified and supplemented. That members of both sexes masturbate is well-known. However, the psychodynamics of any particular case is usually extremely difficult to elicit, and I believe that contrary to Yerkes and Corner, it is Freud's work which laid the basic foundation for studies of the type to be reported here, and that enumeration of data, however statistically valid, in the fashion employed by Kinsey and his group, with no data on unconscious motivation, with no understanding of the individual, but only of one minor fragment of that individual's behavior, will hardly lead to an understanding of the rble of sexual behavior in our culture. It has generally been recognized by the investigators mentioned in the historical part of this paper that I_,SD-25 produces a disturbance of the personality structure, this disturbance being analogous to a schizophrenic-like state in which ego-depression occurs. I believe that this generalization, although valid, must be modified. The effect of LSD-25 depends upon the dosage and upon the personality of the individual. Although ego-depression does occur in the normal individual taking up to 50 micrograms by mouth, I believe that one other process goes on simultaneously, and that process is ego-enhancement, or reinforcement. The ability of the individual under small doses of LSD-25 to face preconscious or unconscious material and to integrate this material into the dynamic forces of the ego-structure is not part of a loss of ego, but rather that of a reinforced ego which functions more effectively under the drug, in the presence of the therapist. A study of the psychoanalytic material of this particular patient after the LSD-25 interview reveals consistently that the experience under LSD-25 gives the patient much more confidence in reconstructing and reevaluating data for an extended period of weeks than had previously been possible without LSD-2.5. This integration usually required very extended periods of

'

154

JOURNAL OF PSYCHOLOGY

therapy. I prefer to think of the process of integration under LSD-25 as distinguished from narcosynthesis, as hebesynthesis, an elated state in which both ego-depression and ego-enhancement may occur simultaneously with the ego-enhancement leading to an increase in the integrative functions of the patient's ego. F. SVM_ARY 1. Lysergic acid dlethylamide (LSD-25) provides a relatively new adjuvant in psychotherapeutic procedures. The use of the drug is characterized by pharmacologic safety, effectiveness in small doses, maintenance of the patient in a conscious and co6perative state, and by safety on repetition without evidence of addiction in both ambulatory and hospitalized patients. 2. Directions are given /or the preparation special particulars for 4-hour psychotherapeutic of ambulatory interviews. patients with

3. A typical 4-hour interview is presented verbatim. A woman of 40 became anxious during psychotherapy because she feared that she was homosexual. During the 4-hour interview under LSD-25 the psychodynamics of this fear of homosexuality was reconstructed in connection with her technique of and fantasy during masturbation with running tap water. 4. Under LSD-25 the integrative processes of the ego became more manifest and she was able to lose her fear of being homosexual. The data indicate that with a low dosage and the technique employed, LSD-25 not only produces the well-recognized schizophrenic-like state with ego-depression but also a simultaneous process occurs that may be termed ego-enhancement. This ego-enhancement leads to hebesynthesis, an elated state in which the processes of ego-reconstruction result in reinforcement of the integrative functions of the ego. 5. The statistical point of view of masturbation (Kinsey et al.) is compared with the value of studying the phenomena within the total configuration of the personality structure. It is held that the solution of the psychodynamic problem of the individual must be part of any realistic evaluation of the meaning of masturbation by the female in our culture. REFERENCES 1. AHRAMSON, A. Technique for screening verbatim psychotherapeutic recordH. ings and its application to a|lergy. Ann. Allergy, 1951, 9, 19-30. 2. ABRAMaON, H. A., JARVlK, M. E., KAUV_IAN, . R., LEVtNE, WAGNER, ., & M A., M KORNETSKV, Lysergie acid diethylamide (LSD-25): I. Physiological and C. perceptual responses. J. of Psychol., 1955, 39, 3-60. 3. BECK_R,A. M. Zur Psychopathologie der Lysergs_iurediaethylarnidwirkung. tFien. _. f. Ner_enhk., 1949, '1 jg, 402-440.

HAROLD

A. ABRAMSON

155

4. 5. 6.

BUSCH, A. K., & JOHNSON, W. System, 1950, 11, 2-4.

'C.

LSD

as an aid

in psychotherapy.

Dis.

Nero.

CONDRAU, G. Klinische Erfahrungen an Geisteskranken mit LysergsiiureDiiithylamid. Acta Psyehlat. et Neurol., 1949, 24, 9-32. DESHoN, H. J., RINKEL, i., &: SOLOMON, H. C. Mental changes experimentally produced by LSD (d-Lysergic acid diethylamide tartrate). Psychoanal. Quart., 1952, 9.6, 33-53. FERVERS, C. Die Narkoanalyse Munchen: Lehmann, 1951. Pp. FORRER, G. R., Lysergic Acid 581-588. als initiale 120. Methode in der Psychotherapie.

7. 8.

& GOLDNER, R. D. Experimental physiological studies with Diethylamide (LSD-25). Arch. Neurol. _ Psychiat., 1951, 65, die Verwendung yon in der Psychotherapie. Die Therapie der Rauschdrogen (Meskalin und Psyche, 1953, 7, 342-364. Schizophrenie. IVien. klin. Beder

9. 10. 11. 12. 13. 14. 15.

FREDERKINO, W. Ueber Lysergs_iurediaethylamid)

HOFF, A., & ARNOLD, O. H. tVehnschr., 1954, 66, 345-351.

KINSEY, A. C., PO_tEROY, W. B., MARTIN, C. E., & GEBHARD, P. H. Sexual havior in the Human Female. Philadelphia: Saunders, 1953. Pp. 842. LASZLO, M. Meskalinund Neur., 1952, 12, 146-147. RINKEL, M., perimental Lysergs_iurediaethylamidrausch. Grenzgeb.

JACKSON, H., DESHON, H. J., HYDE, R. W., & SOLOMON, H. C. Exschizophrenia-like symptoms. Am. J. Psychiat., 1952, 1.08, 572-578. of the LSD treatment of the neuroses.

SANDISON, R. A. Psychological aspects J. Ment. Sci., 1954, 100, 508-515.

SANDISON, R. A., SPENCER, A. M., & WHITELAW, J. D. A. The therapeutic value of lysergie acid diethylamide in mental illness. J. Ment. Sci., 1954, 100, 491507. SLOANE, B., & DOUST, J. W. Psychophysiological investigations in experimental psychoses: results of the exhibition of D-lysergic acid diethylamide to psychiatric patients. J. Ment. Sci., 1954, 100, 129-142. STOLL, W. A. Lysergs_iure-diathylamid, ein Phantasticum aus der Mutterkorngruppe. Sch_eiz. Arch. Neurol. _ Psychiat., 1947, 60, 279-323. STOLL, W. A., & HOFMANN, A. Partialsynthese voln Alkaloiden yon Typus des Ergobasins. Hel_. Chim..Slcta, 1943, 26, 944-965.

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133 East 58th Street New York City 22